Can Mobile Phones Be Used to Reduce Weight and Increase Activity Level

Take home point

A systematic review of the use of apps and text messaging aimed at reducing cardiovascular disease risk found that these technologies have a positive effect on health promoting behaviors.

More than half of the studies reported significant results in at least one outcome of weight loss, physical activity, dietary intake, decreased BMI, decreased waist circumference, sugar-sweetened beverage intake, screen time, and satisfaction/acceptability outcomes.

Problem

While there has been past research on the use of tools like website and email to show they can have an impact on health, there has been little evidence demonstrating the impact of apps or text messaging. As a result, researchers conducted a systematic review of studies on mobile phone technology to determine user satisfaction and effectiveness of smartphone applications and text messaging interventions at promoting weight reduction and physical activity.

Approach to Address Problem

The researchers limited their review to seven studies cited in CINAHL, PubMed, EMBASE, MEDLINE, and PsycINFO and only included studies that were conducted between January 2005 and August 2010. The search was limited to quasi-experimental study designs and randomized controlled trials. The researchers did not include studies that dealt with disease management as the focus was on preventive behaviors.

Innovation

Although the actual study was not that innovative, the review did identify some innovative  interventions. Two of the studies examined participant use of a smartphone application. These smartphones had the capability to record daily calorie intake and consumption, record daily exercise, and show status of daily goals. One particular innovation – The SmartDiet application – provided participants with a diet and exercise game, as well as an avatar that was altered according to their weight change.

Key Results

The app and text messaging interventions resulted in reductions in body weight, waist circumference, body mass index, sugar-sweetened beverage intake, screen time, and resulted in satisfaction or acceptability outcomes.

Implications for clinicians/health care system

Researchers pointed out that the technology has many implications for cardiovascular nurses in particular and that they should be encouraged to ask about a patient’s use or interest in smartphone applications or text messaging. In the future, nurses could help monitor the progress of patients and provide them with feedback as they use these technologies. These technologies could also be useful for not only cardiovascular nurses but also cardiologists and also primary care health professionals. It could be particularly important in primary care settings where patients might be interested in weight reduction, better eating habits, and general behavior which address risk factors for many chronic diseases.

Implications for public health

The researchers posed the question of, “How can successful interventions be translated to populations?” Perhaps public health workers in the field could be trained on the use of these applications for use in community health centers or other community-based settings. Since the studies were not limited to the United States, these technologies have the possibility of being implemented worldwide and in countries facing chronic disease challenges as they move toward more Western lifestyles.

However, there remains an ongoing need for a public health organization and also for professional organizations to develop and implement criteria for determining which apps are best for patients. This type of systematic review can help guide such organizations.

Future research concerns/challenges

The most obvious challenge facing implementation of apps or text messaging to promote healthy behaviors is that patients or people interested in these types of technologies must have smart phones with data plans that allow for text messaging and downloading of applications. This may pose a challenge to low-income populations or other demographics that may not use smartphones. Another concern is that there are few studies that focused on children (under age 18) or the elderly (those above 65). There were limited studies on adolescents but it appears that these two populations merit further study. The researchers also point out that more rigorous trials are needed to determine what parts of the technology or interventions are effective and how to make these interventions cost-effective.

Reference: Stephens J, Allen J. Mobile phone interventions to increase physical activity and reduce weight: a systematic review. J Cardiovasc Nurs. 2013 Jul-Aug;28(4):320-9. doi: 10.1097/JCN.0b013e318250a3e7.

Author:

Perry Payne, MD/JD/MPP

One Response to Can Mobile Phones Be Used to Reduce Weight and Increase Activity Level

  1. Jennie Zhou October 1, 2013 at 1:52 am #

    Dear Mr. Perry Payne Jr.,

    Given the recent growth in healthcare mobile applications, I find that your article is not only timely, but also outlines the great number of benefits that stem from using such apps to promote a healthier lifestyle. I am an avid user of health tracking applications, and have found them to be particularly motivating and impactful in my workout and diet regimen. Like other undergraduate students, I spend a large amount of time on my phone, and the incorporation of fitness reminders into a device that I use so often has made it almost impossible for me to forget about maintaining a healthy lifestyle. While my own experience with these applications is testament to the effectiveness of your proposal, I do feel that the recent release of the final Food and Drug Administration guidelines for regulating mobile healthcare applications may cause issue of concern.

    Since the Food and Drug Administration outlined in these guidelines that healthcare applications, such as those that share in your proposal’s goal of promoting wellness, will not be regulated, I find myself wondering if the agency’s release will impact the overall usage of these apps. I would imagine that a small group of risk-averse individuals may refrain from employing mobile health tracking, as there would be little protection against applications that are not only ineffective, but could also even potentially harm the user. Subsequently, the very purpose of using social media to foster a widespread culture of healthy living could be rendered ineffective for some.

    On the other hand, if the FDA were to regulate these types of applications, the cost that developers would encounter in going through the regulation process could lead to price increases in the application prices that consumers pay. Thus, an interesting conundrum is posed: is the cost of marginalizing risk-averse individuals and inviting potentially untrustworthy applications to the market less than the premium that users may have to pay if these apps were to be regulated?

    As a student studying Computer Science, I feel that the only issue with non-regulated mobile fitness tracking applications would be with privacy of information. Since this risk is essentially shared amongst all apps developed, the people averse to using fitness tracking applications would be the same users opposed to using apps across all industries – for instance, the banking sector. As a result, my take on the issue is that the marginalization of these individuals may be less costly. Additionally, with the looming uncertainty of Obamacare, the government budget would likely not have room for expenditures such as increased regulation of applications that pose little health risk, if at all. However, since healthcare is such a relevant issue for everybody, my proposal would be for companies to engage in some sort of contract with their customers. This contract could outline what the company is and is not responsible for, and would provide the fundamental level of reassurance that some risk-averse consumers may need in order to use such mobile applications. While I acknowledge that this methodology could be overly optimistic, I do envision social media with the capacity to create a culture of healthy living, and would love to hear your insight into the possible issues that the new FDA guidelines may pose.

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